Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Blood pressure variability in controlled and uncontrolled blood pressure and its association with left ventricular hypertrophy and diastolic function

Abstract

High systolic blood pressure (SBP) variability has been associated with higher risk for target-organ damage. In a cross-sectional study done in a tertiary outpatient hypertension clinic, we compared short-term SBP variability among controlled and uncontrolled hypertensive patients and evaluated the association between higher levels of SBP variability and diastolic function and left ventricular hypertrophy (LVH). Patients were evaluated by 24-h ambulatory blood pressure monitoring and transthoracic Doppler echocardiogram. Blood pressure (BP) variability was evaluated by the time-rate index and high variability corresponded to index values in the top quartile of distribution. Echocardiographic parameters were compared in patients with and without higher BP variability within controlled and uncontrolled office BP (140/90 mm Hg). The analyses included 447 patients with 58±12 years of age, 67% were women, 68% white, 43% current or previous smokers and 32% with diabetes mellitus. Among the whole sample, 137 patients had controlled and 310 uncontrolled BP. The 75th percentile cutoff points for the time-rate index were 0.502 mm Hg min−1 and 0.576 mm Hg min−1 for participants with controlled and uncontrolled BP, respectively. After adjustment for confounders, the time-rate index did not differ between controlled and uncontrolled patients. BP variability was not associated with LVH or diastolic function in controlled and uncontrolled BP after adjustment for 24-h SBP and age. Patients with controlled and uncontrolled BP had similar SBP variability assessed by time-rate index, which was not associated with LVH or diastolic function. These findings should be confirmed in studies with larger sample size.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Verdecchia P, Angeli F, Gattobigio R, Rapicetta C, Reboldi G . Impact of blood pressure variability on cardiac and cerebrovascular complications in Hypertension. Am J Hypertens 2007; 20: 154–161.

    Article  Google Scholar 

  2. Dolan E, O'Brien E . Blood pressure variability: clarity for clinical practice. Hypertension 2010; 56: 179–181.

    Article  CAS  Google Scholar 

  3. Parati G, Ochoa JE, Salvi P, Lombardi C, Bilo G . Prognostic value of blood pressure variability and average blood pressure levels in patients with hypertension and diabetes. Diabetes Care 2013; 36 (Suppl 2): S312–324.

    Article  Google Scholar 

  4. Eto M, Toba K, Akishita M, Kozaki K, Watanabe T, Kim S et al. Impact of blood pressure variability on cardiovascular events in elderly patients with hypertension. Hypertens Res 2005; 28: 1–7.

    Article  Google Scholar 

  5. Zakopoulos NA, Tsivgoulis G, Barlas G, Papamichael C, Spengos K, Manios E et al. Time rate of blood pressure variation is associated with increased common carotid artery intima-media thickness. Hypertension 2005; 45: 505–512.

    Article  CAS  Google Scholar 

  6. Wittke EI, Fuchs SC, Fuchs FD, Moreira LB, Ferlin E, Cicherelo FT et al. Association between different measurements blood pressure by ABP monitoring and ankle-brachial index. BMC Cardiovasc Disord 2010; 10: 1–6.

    Article  Google Scholar 

  7. Hansen TW, Lutgarde Thijs L, Li Y, Boggia J, Kikuya M, Björklund-Bodegård K et al. Prognostic value of reading-to-reading blood pressure variability over 24 Hours in 8938 subjects from 11 populations. Hypertension 2010; 55: 1049–1057.

    Article  CAS  Google Scholar 

  8. Mancia G, Bombelli M, Facchetti R, Madotto F, Corrao G, Trevano FQ et al. Long-term prognostic value of blood pressure variability in the general population: results of the Pressioni Arteriose Monitorate e Loro Associazioni Study. Hypertension 2007; 49: 1265–1270.

    Article  CAS  Google Scholar 

  9. Zakopoulos NA, Tsivgoulis G, Barlas G, Spengos K, Manios E, Ikonomidis I et al. Impact of the rate of blood pressure variation on left ventricular mass. J Hypertens 2006; 24: 2071–2077.

    Article  CAS  Google Scholar 

  10. Manios E, Tsagalis G, Tsivgoulis G, Barlas G, Koroboki E, Michas F et al. Time rate of blood pressure variation is associated with impaired renal function in hypertensive patients. J Hypertens 2009; 27: 2244–2248.

    Article  CAS  Google Scholar 

  11. Manios E, Stamatelopoulos K, Tsivgoulis G, Barlas G, Koroboki E, Tsagalis G et al. Time rate of blood pressure variation: a new factor associated with coronary atherosclerosis. J Hypertens 2011; 29: 1109–1114.

    Article  CAS  Google Scholar 

  12. Suchy-Dicey AM, Wallace ER, Mitchell SV, Aguilar M, Gottesman RF, Rice K et al. Blood pressure variability and the risk of all-cause mortality, incident myocardial infarction, and incident stroke in the cardiovascular health study. Am J Hypertens 2013; 26: 1210–1217.

    Article  Google Scholar 

  13. Parati G, Stergiou G, O'Brien E, Asmar R, Beilin L, Bilo G et al. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. J Hypertens 2014; 32: 1359–1366.

    Article  CAS  Google Scholar 

  14. Brazilian Society of Cardiology, Hypertension and Nephrology.. V Brazilian Guidelines for Ambulatory Blood Pressure Monitoring (ABPM V) and III Brazilian Guidelines for Home Blood Pressure Monitoring (HBPM III). Arq Bras Cardiol 2011; 97 (3 Suppl 3): 1–24.

    Google Scholar 

  15. Schillaci G, Pucci G, Parati G . Blood pressure variability: an additional target for antihypertensive treatment? Hypertension 2011; 58: 133–135.

    Article  CAS  Google Scholar 

  16. Fuchs SC, Ferreira-da-silva AL, Moreira LB, Neyeloff JL, Fuchs FC, Gus M et al. Efficacy of isolated home blood pressure monitoring for blood pressure control. J Hypertens 2012; 30: 75–80.

    Article  CAS  Google Scholar 

  17. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2014; 37 (Suppl 1): S81–90.

    Article  Google Scholar 

  18. Brazilian Society of Hypertension.. VI Brazilian guidelines on hypertension. Arq Bras Cardiol 2010; 95 (Suppl 1): 1–51.

    Google Scholar 

  19. Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013; 31: 1281–1357.

    Article  CAS  Google Scholar 

  20. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18: 1440–1463.

    Article  Google Scholar 

  21. De Simone G, Devereux RB, Daniels SR, Koren MJ, Meyer RA, Laragh JH . Effect of growth on variability of left ventricular mass: assessment of allometric signals in adults and children and their capacity to predict cardiovascular risk. J Am Col Cardiol 1995; 25: 1056–1062.

    Article  CAS  Google Scholar 

  22. Foppa M, Duncan BB, Rohde LEP . Echocardiography-based left ventricular mass estimation. How should we define hypertrophy? Cardiovascular Ultrasound 2005; 3: 17.

    Article  Google Scholar 

  23. Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G et al. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. J Am Soc Echocardiogr 2011; 24: 277–313.

    Article  Google Scholar 

  24. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 2009; 22: 107–133.

    Article  Google Scholar 

  25. Okin PM, Devereux RB, Jern S, Kjeldsen SE, Julius S, Nieminen MS et al. Regression of electrocardiographic left ventricular hypertrophy by losartan versus atenolol: The Losartan Intervention For Endpoint Reduction in Hypertension (LIFE) Study. Circulation 2003; 108: 684–690.

    Article  CAS  Google Scholar 

  26. Brazilian Society of Cardiology. Guidelines of the Brazilian Cardiology Society for electrocardiographic analysis and issue reports (2009). Arq Bras Cardiol 2009; 93 (3 suppl 2): 1–19.

    Google Scholar 

  27. Zis P, Vemmos K, Spengos K, Manios E, Zis V, Dimopoulos MA et al. Ambulatory blood pressure monitoring in acute stroke: pathophysiology of the time rate of blood pressure variation and association with the 1-year outcome. Blood Press Monit 2013; 18: 94–100.

    Article  Google Scholar 

  28. AlJaroudi W, Alraies MC, Halley C, Rodriguez L, Grimm RA, Thomas JD et al. Impact of progression of diastolic dysfunction on mortality in patients with normal ejection fraction. Circulation 2012; 125: 782–788.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M Gus.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wittke, E., Fuchs, S., Moreira, L. et al. Blood pressure variability in controlled and uncontrolled blood pressure and its association with left ventricular hypertrophy and diastolic function. J Hum Hypertens 30, 483–487 (2016). https://doi.org/10.1038/jhh.2015.106

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2015.106

This article is cited by

Search

Quick links